Bhutan has come a long way in improving maternal and newborn health. From the prevalence of myths and taboos around pregnancy to the implementation of the Safe Motherhood Programme and the Bhutan Newborn Action Plan
In the remote village of Tashi Zangmo, life was vastly different than it is today. Growing up in the mid-teen years, Tashi recalls how pregnancy was a taboo topic, with pregnant women not telling anyone outside of their family, and even then, only select members knew. It was a fear of demons stealing the unborn baby that fueled this secrecy, a myth that was prevalent throughout the community.
According to Tashi, it wasn’t uncommon for women to suffer miscarriages or stillbirths during those times. As a result, women would avoid revealing their pregnancy for fear of attracting the evil eye, which would harm the baby. Even a mother’s own mother would not be told, let alone visits to hospitals for maternal care.
This lack of care and attention during pregnancy resulted in many children dying in the womb or shortly after birth.
It wasn’t until 1994 when the Safe Motherhood Programme was launched in Bhutan, as part of the primary healthcare system, that organized activities addressing maternal health began.
With time, Bhutanese women began to understand the importance of maternal health care, resulting in a significant reduction in maternal and infant mortality rates. The maternal mortality rate dropped from 255 deaths per 100,000 live births in 1990 to 86 deaths per 100,000 in 2012, while infant and under-five mortality rates also decreased.
These improvements are a testament to Bhutan’s dedication to improving healthcare access and services for its citizens.
According to Dr. Lobzang Dorji, the National Professional Officer of the World Health Organization in Bhutan, the maternal mortality rate in Bhutan is currently 89 per 100,000 live births, infant mortality rate is 15.1 per 1000 live births, and children under five mortality rate is 34.1 per 1000 live births.
Dr. Dorji emphasizes that in the 21st century, a mother dying during childbirth is unacceptable, as it reflects poorly on government leadership and health systems, and orphans suffer long-term consequences.
The Bhutan Every Newborn Action Plan (2016-2023) outlines initiatives such as Safe Motherhood and Child Survival, Postnatal home visits for mothers and newborns, the National Child Health Strategy (2014-18), the National Maternal and Neonatal Mortality Review, and the tracking of every mother and child through the Mother and Child Health (MCH) Handbook.
These initiatives aim to improve the health of newborns in the country, with the Bhutan Newborn Action Plan (BENAP) serving as a roadmap towards accelerating the reduction of newborn deaths. The BENAP outlines a set of interventions with priority actions for addressing newborn issues in the country, covering different life stages of a newborn.
These actions are expected to strengthen neonatal services in the country, harnessing the concerted efforts of stakeholders towards the achievement of all health-related Sustainable Development Goals.
Tashi looks back on her life and is grateful for the progress made in maternal and neonatal healthcare. She hopes that Bhutanese women continue to take advantage of maternal healthcare services and that the government continues to prioritize healthcare improvements for all its citizens
Meanwhile, UNICEF Bhutan has said that it witnessed unprecedented progress in child and maternal health over the last two decades. This is evident from the two-third reduction in maternal deaths: from 255 per 100,000 live births in 1990 to 86 per 100,000 in 2012. UNICEF Bhutan’s Health programme is in line with the Royal Government’s objectives of improving Mother and Child Health (MCH); reducing infant, child and maternal mortality; and sustaining high immunization coverage.
UNICEF has helped the country sustain immunization coverage of more than 90 per cent since achieving Universal Child Immunization in 1991. Together with the government and other partners, UNICEF continues to give priority to improve both quality and coverage of immunization services for all eligible children and women across the country. This includes making vaccines and cold chain equipment available at all health facilities and building capacity of service providers for effective vaccine management, injection safety and maintenance of cold chain equipment.
Together with the Royal Government, the Bhutan Every Newborn Action Plan was rolled out since 2017.UNICEF also starting the Child Development Screening Tool to identify birth defects, developmental delays and disability in under-five children, for timely intervention. Early Infant Diagnosis Tool was also implemented to achieve zero vertical (mother to child) transmission of HIV by 2020.
According to the World Health Organization (WHO), in 2020, Bhutan’s under-5 population was 8% ; total adolescent population 18%; women in reproductive age group 27%; total fertility rate 2.0 and adolescent birth rate 28 per 1000 population. Births registered was 100%
The same report states that there was a 57% reduction in MMR between 2000 and 2017; 60% reduction in neonatal mortality rate between 1990 and 2019 and 78% reduction in under-5 mortality rate between 1990 and 2019 A paper by Choni Wangmo, Community Health Department, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, says that despite 88.4% reduction in maternal mortality between 1984 and 2017, Bhutan remains 70 years behind the United Kingdom. Due to difference in resource availability, disparity in access to specialized care and high-end investigations are expected. Fortunately, the variations in Routine Perinatal Care (RPC) are adjustable. Therefore, instead of complete reliance on existing long-term policy-level strategies, initiating a robust maternal mortality reviews and report dissemination; tied with a well-formulated quality metrics for RPC may contribute significantly towards achievement of SDG target 3.1: to reduce global Maternal Mortality Ratio to less than 70 per 100000 live births by 2030.
Tshering Pelden from Thimphu